Change Request Viewer

Change Requests for X12 Work Products

720

New Search Option (excluding Member ID)

Submitted: 3/24/2011

Primary Work Group: X12N/TGB/WG1 - Benefit Information

Business Reason

Description

Indirect providers are dependent on referring providers to supply patient demographic information required for billing. The referring provider does not have a vested interest in supplying the billing information. The referring provider's focus is on patient care and acquiring the services needed for their patient. This situation creates a scenario where the billing demographic information may not be fully disclosed or may be incorrect. Currently the required search options supported by the eligibility transactions all require a member ID. There is an alternate search option that is not required that provides a mechanism for an eligibility search if the member ID on record proves to be incorrect. With the current required search options, a provider that has an incorrect member ID has no way to gather eligibility information.

Please consider adding the search option that does not require a member ID to the list or required search options. In 2007, providers reached a compromise with payers that this search option would be available but not required. This compromise was made to allow payers time to address changes in their systems where security is driven by member IDs.